Method and Apparatus for Optimization of Cardiac Resynchronization Therapy Using Vectorcardiograms Derived from Implanted Electrodes

Abstract

A cardiac resynchronization pacemaker and a method of adjusting the pacemaker. The method includes deriving a vectorcardiogram from implanted electrodes (D-VCG), analyzing the D-VCG, deriving optimal CRT pacing parameters from the analysis of the D-VCG, and adjusting the CRT pacemaker according to the derived parameters. The pacemaker may include a processor configured to perform the method.

1 . A method of adjusting a cardiac resynchronization (CRT) pacemaker of the type having the capabilities of left ventricular pacing and atrial sensing, comprising:
 deriving a vectorcardiogram from implanted electrodes (D-VCG);   analyzing the D-VCG;   deriving optimal CRT pacing parameters from the analysis of the D-VCG; and   adjusting the CRT pacemaker according to the derived parameters.   
     
     
         2 . A method according to  claim 2  further comprising storage of the D-VCG for diagnostic purposes. 
     
     
         3 . A method according to  claim 1 , wherein the derived pacing parameters include an atrial to left ventricular (A-LV) and an atrial to right ventricular (A-RV) pacing interval. 
     
     
         4 . A method according to  claim 1 , wherein the derived pacing parameters include an atrial to left ventricular (A-LV) pacing interval. 
     
     
         5 . A method according to  claim 1  wherein the derived parameters include an optimal electrode location. 
     
     
         6 . A method according to  claim 1  wherein the analysis of the D-VCG comprises measurement of QRS vector area (QRSVarea). 
     
     
         7 . A method according to  claim 6  wherein the optimal pacing parameters comprise those that result in a minimum QRSVarea. 
     
     
         8 . A method according to  claim 1  wherein the analysis of the D-VCG comprises measurement of QRS vector perimeter. 
     
     
         9 . A method according to  claim 1  wherein the analysis of the D-VCG comprises measurement of QRS vector amplitude. 
     
     
         10 . A method according to  claim 1  further comprising employing the obtained D-VCG to detect loss of capture, due to technical failure of the pacemaker or lead, irregular heart beats or altering cardiac conduction properties. 
     
     
         11 . A method according to  claim 1  wherein analysis of the D-VCGs comprises identification of start and endpoints of QRS complexes. 
     
     
         12 . A method according to  claim 1  wherein the analysis of D-VCGs comprises performing the analysis in conjunction with delivery of CRT pacing using different pacing parameters. 
     
     
         13 . A method according to  claim 1  wherein the analysis of D-VCGs comprises performing the analysis in conjunction with delivery of CRT pacing using different pacing electrode configurations. 
     
     
         14 . A cardiac resynchronization (CRT) pacemaker of the type having the capabilities of left ventricular pacing and atrial sensing, and comprising a set of implanted electrodes, comprising:
 a processor configured to:
 a) derive a vectorcardiogram from the implanted electrodes (D-VCG); 
 b) analyze the D-VCG; 
 c) derive optimal CRT pacing parameters from the analysis of the D-VCG; and 
 d) control delivery of CRT pacing according to the derived parameters. 
   
     
     
         15 . A device according to  claim 14  further comprising memory configured to store the D-VCG for diagnostic purposes. 
     
     
         16 . A device according to  claim 14 , wherein the derived pacing parameters include an atrial to left ventricular (A-LV) and an atrial to right ventricular (A-RV) pacing interval. 
     
     
         17 . A method according to  claim 14 , wherein the derived pacing parameters include an atrial to left ventricular (A-LV) pacing interval. 
     
     
         18 . A method according to  claim 14  wherein the derived parameters include an optimal electrode location. 
     
     
         19 . A method according to  claim 14  wherein the analysis of the D-VCG comprises measurement of QRS vector area (QRSVarea). 
     
     
         20 . A method according to  claim 19  wherein the optimal pacing parameters comprise those that result in a minimum QRSVarea. 
     
     
         21 . A method according to  claim 14  wherein the analysis of the D-VCG comprises measurement of QRS vector perimeter. 
     
     
         22 . A method according to  claim 14  wherein the analysis of the D-VCG comprises measurement of QRS vector amplitude. 
     
     
         23 . A method according to  claim 14  further comprising employing the obtained D-VCG to detect loss of capture, due to technical failure of the pacemaker or lead, irregular heart beats or altering cardiac conduction properties. 
     
     
         24 . A method according to  claim 14  wherein analysis of the D-VCGs comprises identification of start and endpoints of QRS complexes. 
     
     
         25 . A method according to  claim 14  wherein the analysis of D-VCGs comprises performing the analysis in conjunction with delivery of CRT pacing using different pacing parameters. 
     
     
         26 . A method according to claim  41  wherein the analysis of D-VCGs comprises performing the analysis in conjunction with delivery of CRT pacing using different pacing electrode configurations.